Manager, Medicaid Integrity Operations, Financial Crime and Fraud
About The Position
Deloitte’s Regulatory, Risk & Forensic team helps clients respond to complex risks and changing regulatory requirements through advanced data, AI, emerging technologies, and industry expertise. This Manager role supports Medicaid program integrity engagements within Deloitte’s Government & Public Services practice and Enterprise Operations & Risk offering. The manager oversees delivery across multiple state Medicaid program integrity engagements, including contract commitments, operational planning, resources, quality, performance, and risk. The role supervises project managers and other delivery personnel and provides senior expertise in provider oversight, claims auditing, payment integrity, fraud and abuse detection, and improper payment recovery. It also serves as an operational liaison with state agency leaders, supports quality assurance and oversight responses, contributes to proposals and new contract planning, and identifies emerging client needs and opportunities for service improvements. Travel averages 5–25%, depending on assignments and clients.
Requirements
- Bachelor’s degree.
- 10+ years of progressively responsible experience in Medicaid program integrity, payment integrity, healthcare auditing, compliance, or related government healthcare operations.
- 5+ years of leadership experience managing personnel, operational teams, program integrity initiatives, contracts, or complex healthcare programs.
- Ability to travel 5–25% on average, depending on work and clients.
- Must be legally authorized to work in the United States without employer sponsorship now or in the future.
- Ability to work independently and collaboratively as part of a team.
- Effective written and verbal communication skills.
- Meticulous attention to detail and quality of work product.
- Ability to build and sustain professional relationships.
- Ability to lead projects or workstreams and provide clear guidance to others.
- Ability to manage and prioritize multiple tasks in a fast-paced, dynamic environment and meet deadlines.
- Strong interpersonal skills and professional demeanor.
Nice To Haves
- Experience with Medicaid recovery audit contractors, prepayment predictive analytics, postpayment review, provider audits, and improper payment recovery.
- Experience procuring, implementing, or operationally managing program integrity technology, claims processing, analytics, or pace management tools.
- Experience with vendor contracts, procurement, statements of work, regulatory audits, corrective action activities, or legislative and executive presentations.
- Experience working with Midwestern state Medicaid agencies, including familiarity with regional program integrity priorities, operations, and stakeholder environments.
- Certified Professional Coder (CPC), Certified Program Integrity Professional (CPIP), or comparable professional certification.
Responsibilities
- Oversee delivery across multiple state Medicaid program integrity engagements, including statements of work, milestones, service levels, quality standards, and client commitments.
- Direct operational planning, resource allocation, delivery reviews, risk identification, escalations, and corrective action planning with project managers and account leaders.
- Directly supervise assigned project managers, auditors, analysts, program integrity specialists, and other delivery personnel as appropriate to the contract portfolio.
- Provide senior expertise in Medicaid provider oversight, claims auditing, prepayment and postpayment review, payment integrity, fraud and abuse detection investigations, and improper payment recovery.
- Guide risk-based audit and review approaches, provider billing assignments, emerging scheme identification, documentation standards, and defensible findings.
- Apply knowledge of state Medicaid agency operations and private-sector vendor delivery to align contracted services with agency objectives and operational realities.
- Serve as a senior operational liaison between agency program integrity leaders and internal teams to clarify requirements, resolve issues, and improve execution.
- Define and monitor performance measures for contract delivery, staff productivity, quality, audit effectiveness, prevention, recovery, and client satisfaction.
- Maintain documentation, quality assurance, reporting, and operational controls; support responses to audits and oversight reviews.
- Contribute Medicaid program integrity expertise to proposals, client demonstrations, client discovery, and new contract operational planning.
- Surface emerging client needs, program integrity risks, and opportunities for product or service improvements to executive and product leadership.
- Work independently and collaboratively, communicate effectively, maintain professional relationships, lead projects or workstreams, prioritize multiple tasks, meet deadlines, and provide clear guidance to others.
Benefits
- Employees are offered a broad range of benefits.
- Potential eligibility for a discretionary annual incentive program, subject to its rules and relevant factors.
- Opportunities for professional development, including on-the-job learning, formal development programs, leadership opportunities, and mentorship.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
